Experience with 350 Crural Arterial Reconstructions: Analysis and Conclusions

Summary

Distal arterial reconstructions differ from those in the pelvic and femoral region in the following 3 characteristics:

• wound healing is endangered by ischemic tissue;

• vessel diameters are very small;

• poor outflow conditions can reduce blood flow velocity in the long femorocrural grafts thus increasing the risk of reocclusion.

On the basis of clinical and angiographic follow-up studies we investigated retrospectively various factors influencing the long-term results:

• bypass material;

• poor outflow;

• technique of distal insertion;

• location of the bypass graft.

Conclusions:

• autologous vein provides the best, umbilical vein the second best arterial substitute. Prosthetic material is less satisfactory.

• AV-fistulae can be successfully employed to reduce peri pheral outflow resistance;

• Short bypass lengths can be achieved by proximal end-to-side and distal end-to-end anastomoses;

• orthotopic location of the bypass yields the best long-term results.

Key words

Femoro-crural bypass - Operative technique - AV-fistula